Blam! – first is Public Health: Even though traditional healers are held in high regard by the population throughout Africa, post-colonial laws keep them out of the national health systems. In addition, pressure from Western medicine guarantees that this won’t change any time soon.
Erick V. A. Gbodossou, President of PROMETRA (Association For the Promotion of Traditional Medicine) International, Virginia Davis Floyd, Visiting Scholar in Traditional Knowledge Systems at Spelman College and Executive Director of PROMETRA, and Charles Ibnou Katy, coordinator of research and patient services at the Center for Experimental Traditional Medicine, ‘03 ("The Role of Traditional Medicine in Africa’s Fight Against HIV/AIDS," PROMETRA International, www.prometra.org/Documents /AIDSinAfrica-ScenariofortheFut ure.pdf)
Surprisingly, even though the majority of the African population utilizes traditional medicine services, in many African nations traditional medicine technically remains illegal. The World Health Organization’s 2001 survey of the legal status of traditional and complementary/alternative medicine revealed that of the 44 African nations surveyed, 61% had legal statutes regarding traditional medicine. 5 However, even with legal statues in place, national policies have not always been implemented. Often the certifying or authorization mandate is assigned to a local governmental authority without national uniformity. Seventeen nations have local and national councils to address traditional medicine. Varying degrees of involvement with the national health care system are listed. No African nation surveyed provided insurance or financial reimbursement for traditional medicine services. WHO classifies the collaboration between national health care and traditional medicine systems as either integrative, inclusive or tolerant. No African nation exemplifies an integrative system; two (Ghana and Nigeria) are classified as inclusive; the majority fit the description of tolerant systems.In this category the national health care system is based entirely on allopathic medicine, but some TM/CAM practices are tolerated by law. As a legacy of the long history and remnants of European colonization, antiquated laws remain on the books outlawing the practice of traditional medicine. These laws are often overlooked and the practice of traditional medicine is accepted and tolerated throughout the continent. Pressure from organized western medicine also helps to sideline traditional medicine, keeping it out of the policy discussions and specifically out of national health care strategic plans and official systems.
Lack of medical pluralism creates gaps in infrastructure that inhibits public health programs in Africa
Chidi Oguamanam, Director of Law and Tech Institute @ Dalhousie University, 2006, International Law and Indigenous Knowledge, pg. 9-11 Traditional healers have unique cultural position within society that makes them influential in stopping HIV/AIDS and combating the social stigma associated with AIDS The Nation June 8, 2007 Friday “Africa Insight - It's Time the West Accepted Africa's Traditional Healers” Lexis Africa's traditional healers can be most instrumental in HIV and Aids prevention. For starters, these specialists treat most of the cases of STDs and experts believe that STDs are major co-factors in the spread of HIV. Secondly, in developing countries with poor infrastructure, these healers are located in nearly every rural village setting as well as in the busy urban areas. Therefore, they are a godsend to Africa's cash-strapped health ministries since they are already "on the ground". Traditional healers in Africa are also quite knowledgeable about HIV and Aids. For example, urban traditional healers in Tanzania know very well about the opportunistic infections caused by HIV and Aids and what herbal medicines can treat them. They know too that a healthy diet and treatment of sexually transmittable diseases can greatly help in maintaining good health for PLWHAs besides keeping HIV-infection at bay. Furthermore, they are also aware that high fevers from malaria, for instance, can weaken the body even further if one is HIV-positive. They also tell their patients not to engage in sexual activity because it cannot only further the spread the virus but also weaken their immune system. Even something as simple as a massage can have great physical and psychological benefits since it both relieves PLWHAs of excruciating pains in their lower limbs but it also gives them existential reassurance since they know that few want to touch someone with HIV and Aids. Simply dishing out ARVs is not enough. PLWHAs in Africa need appropriate social counselling and "pyschic" support and indigenous healers can provide the appropriate emotional, psychological, spiritual counselling. For example, such counselling would deal with reducing social stigmatization (something that even PLWHAs in the West continue to experience but is offered little help from Western biomedicine and social services.
AIDS stigmatization creates a culture of silence that discourages treatment fueling a ticking time bomb -
JM Spectar, Ph.D "The Hydra Hath But One Head: the socio-cultural dimensions of the AIDS epidemic and women's right to health" Boston College Third World Law Journal, Winter 2001, p. lexis
In addition, some women with AIDS are not only denied access to health care, jobs, and housing, but are "even murdered." **46**UNAIDS reports that "women who are often monogamous wives infected by their husbands are especially stigmatized." 47 Women with HIV are often "blamed by their in-laws for the fate of their infected spouse, even in cases when they themselves are not infected." 48 Sometimes, when a man dies of AIDS, his spouse "risks being thrown out of her home by her in-laws, often losing her children in the process." 49 A recent study by the Food and Agriculture Organization (FAO) in Namibia found "gender bias" in the treatment of women with AIDS: households headed by HIV-infected women generally lose their livestock, "thus jeopardizing the food and security of surviving members." 50 During an official trip to Africa, U.S. Ambassador Richard Holbrooke spoke poignantly of a visit with six HIV-infected pregnant women in Wind-hoek, Namibia, who had met with the U.S. delegation clandestinely because of the stigmatization and shame linked with the disease: These women told us that if they even admitted their ailment, they would lose their husbands and families, their jobs, and are completely ostracized from society. Under such circumstances, these women are simply left to die. . . . In too many places, families (and many doctors) even refuse to recognize AIDS as a cause of death. Often, they'll cover it up by attributing death to AIDS-related illnesses like pneumonia. **51** [*9] The stigmatization of AIDS further lessens the likelihood of its successful prevention or treatment because many at-risk persons might be "discouraged from obtaining the necessary information, goods and services for self-protection." **52**If women with AIDS face rejection and other violations of their human rights, women who suspect they are HIV-infected may avoid getting tested and may be disinclined to take "precautionary measures with their partners, for fear of revealing their infection; they may even avoid seeking health care."53The silence surrounding AIDS creates "a pandemic time-bomb waiting to explode," especially in areas of the developing world where most infected persons do not even know they are infected. 54 UNAIDS reports that in countries such as India, "the association between HIV and promiscuous sexual behaviour has created a belief that people who are infected with HIV somehow deserve their fate."__55__The stigmatization of AIDS as a moral failing often fuels a syndrome of silence that, in turn, places many women and young girls in further jeopardy.
Unchecked AIDS will cause extinction. Muchiri, 2K
(Jakarta Post, March 6, Lexis)
There is no doubt that AIDS is themost serious threatto humankind, more serious than hurricanes, earthquakes, economic crises, capital crashes or floods. It has no cure yet. We are watching a whole continent degenerate into ghostly skeletons that finally succumb to a most excruciating, dehumanizing death. Gore said that his new initiative, if approved by the U.S. Congress, would bring U.S. contributions to fighting AIDS and other infectious diseases to $ 325 million. Does this mean that the UN Security Council and the U.S. in particular have at last decided to remember Africa? Suddenly, AIDS was seen as threat to world peace, and Gore would ask the congress to set up millions of dollars on this case. The hope is that Gore does not intend to make political capital out of this by painting the usually disagreeable Republican-controlled Congress as the bad guy and hope the buck stops on the whole of current and future U.S. governments' conscience. Maybe there is nothing left to salvage in Africa after all and this talk is about the African-American vote in November's U.S. presidential vote. Although the UN and the Security Council cannot solve all African problems, the AIDS challenge is a fundamental one in that it threatens to wipe out man. The challenge is not one of a single continent alone because Africa cannot be quarantined. The trouble is that AIDS has no cure -- and thus even the West has stakes in the AIDS challenge. Once sub-Saharan Africa is wiped out, it shall not be long before another continent is on the brink of extinction.Sure as death, Africa's time has run out, signaling the beginning of the end of the black race and maybe the human race.
Contention 2 is Cultural Genocide: Traditional Healers are the primary agent holding together indigenous cultures in Sub-Saharan Africa. Puckree Department of Physiotherapy @ University of Durban, 2002, International Journal of Rehabilitation Research, Lexis Traditional healing has been an integral but unrecognized component of the South African health care system.In recent years it has been receiving increasing attention and recognition as a vital component of the primary health care system. It has been legislated for and traditional healers can apply for licences and now call themselves ‘doctors’. As many as 400 000 recognized traditional healers serve health care in South Africa (Gumbi, 1996). The number of ‘quack’ traditional healers exceeds this number. Gumbi (1996) stated that 60–80% of the African population regularly utilizes the services of traditional healers. The number of Western-style doctors and health care personnel in the province of Kwa-Zulu Natal or South Africa is too small to meet the actual health care needs of the province and country. In order to rationalize and make health care accessible to all, and cost effective, there must be an integration and rationalization of health care providers regardless of whether they are traditionally or Western trained. In order to achieve this aim, Western-trained health care professionals need to know the exact role of the traditional healer in the provision of heath care in the province. Culturally, the traditional healer plays an intrinsic role in a patient's life and in the community in which they live. Illnesses perceived to be of supernatural origin are managed together with their physical manifestations so that the patient feels as if they have been treated holistically. The African patient has mostly used Western medicine to supplement the traditional healers' services or as a last resort (Gumbi, 1996). Western-trained health care practitioners ignore these facts. Despite this, some traditional herbal medicines are now being scientifically evaluated and validated. There are three categories of African traditional healers in South Africa. The Izinyangas are the herbalists who use herbs and other preparations for treating diseases. The Sangomas operate within a religious supernatural context. The faith healers' health care integrates Christian ritual and traditional practices (Pretorius, 2001). Traditional healing has found a recognized niche in the health care system and the national government has legislated a rationalized system of health care to deliver services to all its citizens. Therefore it is vital for physiotherapists and other health care professionals to understand, evaluate and embrace these health care practitioners to provide safe evidence-based care to the community. The purpose of the present study was to determine the role of traditional healers in Durban, the number of patients who consulted traditional healers, the types of conditions treated and the frequency of consul-tations. The opinions about physiotherapy of the patients who frequently consult traditional healers were also explored.
Culture is Key to Identity Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007.] The study of culture is shrouded in identity politics. Culture is so much a part of identity that the two words are often coupled to produce cultural identity. What is certain is that for identity to have meaning, it is directly or indirectly associated with culture.The meanings that are ascribed to one's group identity, therefore, have a strong historical and social meaning that goes beyond individual choice of identity. For example, knowing one's racial or ethnic identity in the United States and South Africa reveals more of the societal arrangements and identity politics than any text of individual understanding of one's biological being. It is the strength and salience of social arrangements, often anchored in the politics of difference, that necessitate a globally relevant and inclusive definition of group identity-culture. Culture is what defines our identity. Even when we claim dual or multiple cultures, our primary culture of reference is where we seek refuge in times of difficulty.
Contention 3 is Biodiversity: The Western approach to medicine leads to the destruction of biodiversity
Chidi Oguamanam, Director of Law and Tech Institute @ Dalhousie University, 2006, International Law and Indigenous Knowledge, pg. 53-54 Thus the plan: The United States Federal Government should provide all nessecary funding for the integration of traditional healers into national public health infrastructures in Sub-Saharan Africa.
Funding and Enforcement Guaranteed
Contention 4 is Solvency: Integration of traditional medicine is crucial to perceptual diversity – this increases knowledge, biodiversity, cultural diversity, and continued evolution
Tara W. Lumpkin, Anthropogist with development experience, 2001. “Perceptual Diversity: Is Polyphasic Consciousness Necessary for Global Survival?” Anthropology of Consciousness. Vol. 12, No. 1, pp. 37-70 Perceptual diversity allows human beings to access knowledge through a variety of perceptual processes, rather than merely through everyday waking reality. Many of these perceptual processes are transrational altered states of consciousness (meditation, trance, dreams, imagination) and are not considered valid processes for accessing knowledge by science (which is based primarily upon quantification, reductionism, and the experimental method). According to Erika Bourguignon's (1973) research in the 1970s, approximately 90 percent of cultures have institutionalized forms of altered states of consciousness, meaning that such types of consciousness are to be found in most human societies and are "normal." Now, however, transrational consciousness is being devalued in many societies as it is simultaneously being replaced by the monophasic consciousness of "developed" nations. Not only are we are losing (1) biodiversity (biocomplexity) in environments and (2) cultural diversity in societies, we also are losing (3) perceptual diversity in human cognitive processes.All three losses ofdiversity (bio, cultural, and cognitive) are interrelated. Cultures that value perceptual diversity aremore adaptablethan cultures that do not. Perceptually diverse cultures are betterable to understandwhole systems (because they use a variety of perceptual processes to understand systems) thanare cultures that relyonlyon the scientific method, which dissects systems. They also are better stewards of their environments, because theygrasp the valueof the whole of biodiversity (biocomplexity) through transrationalas well asscientific processes. Understanding through perceptual diversity leads to a higher degree of adaptability and evolutionary competence. From the perspective of an anthropologist who has worked with development organizations, development will continue to destroy perceptual diversity because it exports the dominant cognitive process of "developed" nations, i.e., monophasic consciousness. Destroying perceptual diversity, in turn, leads to the destruction of cultural diversity and biocomplexity. Drawing from research I conducted among traditional healers in Namibia, I conclude that development organizationsneed to listento those who use transrational perceptual processes and also need to find a way toincorporateand validate perceptual diversity in their theoretical and applied frameworks.
Problems in Africa’s health system could be solved by an integration of traditional healers. Healers reach those whom are overlooked by western medicine, are easily capable of gaining trust of patients, and provide psychological help to patients
Saajk Van der Geest, Medical Anthropology Professor @ University of Amsterdam, 1997, Tropical Medicine and International Health, Volume 2, No. 9, pg 903-910
Only by interrogation of assumptions from our privileged status can we properly engage culture and hope for solvency. Our integration project and concurrent acceptance of culture reveals the truth about cultural paradigms and breaks down the often Eurocentric and patriarchal foundations we usually engage in to achieve public health goals. Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007. 195] The discourse on identity and global health is incomplete without the proper anchor on culture. Culture should be central to public health and health promotion intervention strategies in a manner that does not naturally couple the concept of barriers with culture. Intervention projects should draw on the possibilities offered in critical theories that lay bare institutional and Western hegemonies that continue to truncate ef/'(xts to address public health issues in Africa. Stuart Hall ( 1992) notes that cultural hegemony is about imbalance of power, and our responsibility, as echoed by Okri at the beginning of this chapter, is the struggle for a balance of power to achieve the best that our humanity exemplifies in social justice. I have attempted to remap the terrains of conventional theories and cultural logics in health promotion, health communication, and public health by placing them within their particular cultural spaces. By so doing, it is possible to acknowledge that everyone has a culture and that all knowledge production is cultural, and thus all theory is cultural. Such a premise unveils the contextual anchors for theoretical assumptions and praxis so that behaviors are located within cultural spaces. These behaviors are then expressed through different forms of identity as expressed in different behavioral response to health and the lack thereof. What I have attempted in this book is to locate identity and behavior within cultural contexts of health. Thus, it was necessary to challenge existing public health epistemologies by decentering conventional views of health behavior and inserting and centering culture into their theories and practices.
As I have discussed throughout this book, a major requirement in engaging a health and culture project is that we begin with the interrogation of conventional assumptions and classical paradigms and their attendant Eurocentric and often patriarchal foundations. Such interrogation is meant to be a cleansing enterprise that must be engaged in by both the privileged and the marginalized as a liberatory process that allows questioning to become a form of answering. While the privileged interrogate the hegemonic tools of oppression that privilege them, the oppressed and marginalized interrogate their conscious or subconscious participation in promoting ways of knowing that evidently silence their own agency in policies of identity inscribed in the crisis of global health.
US action is key-- United States health policies are modeled around the world and we have a moral obligation to advance public health
.
Dr. Solomon R. Benatar, Department of Sociology and Center for Bioethics, University of Pennsylvania. 2005 Meeting Threats to Global Health: A Call for American Leadership. Correspondence. Summer.]
This paper, by a South African physician and an American medical sociologist, considers challenges that face global health, health care professionals, and governments at the beginning of the 21st century. Our reflections rest on three major premises: that global health problems pose major medical, social, and economic threats to all countries; that it is in the long-term self-interest of wealthy nations to address the forces that significantly affect the health of whole populations; and that at this historical juncture, theUnited States is the country with the most potentialfor favorably influencing global health trends. In addition to discussing the nature of threats to global health, we explore some of the major impediments to efforts that could be undertaken to foster alterations in policies that would effectively address the tragic discrepancies in health care and research that currently exist, and to overcome global apathy to the HIV/AIDS pandemic (Hogg et al. 2002). These obstacles involve a confluence of important American values, exemplified by political ideologies that have global as well as national health import; the prevailing ethos of bioethics in the United States; and the current views of many other countries towards the international policies and actions of the United States.
As sociologist Robert N. Bellah (2002) has provocatively stated, in and through the "relentless" process of globalization, the United States has become a "culturalmodel and economicdynamo" as well as a military superpower, and more "by default" than by intention, a country with "imperial power." In our view, because of its singularity in these respects (for better or for worse), the United States not only has thescientific,political, andeconomiccapacityto assume major responsibility for improving world health, but also the moral obligation to exemplify and implement values in action that are conducive to this advancement. We make this statement with two caveats. First, we are wary about [End Page 345] unduly promoting the dominance of American influence in the world by encouraging its moral hegemony in global health. Second, as noted above, we are mindful of the cultural and political factors that curtail the readiness and willingness of the United States to assume such a leadership role, and that contribute to health inequities in the American health care system that call for reform rather than emulation. We believe, however, that these caveats should be superseded by the moral imperative of facing up to national and global threats posed by disparities in health and emerging epidemics. Moreover, we believe that the long-term interests of Americans, and indeed of all privileged people and their societies, will be served by major improvements in global health (Benatar 2003). (…)
"The way medicine is practiced in the United States has a strong influence on the rest of the world, for better or for worse," a Swiss physician has written (Mosimann 2002).
US action to integrate healers gives traditional medicine the legitimacy that is critical to acceptance by the allopathic community International Nursing Review, September 2002, Volume 49, Issue 3, Page 161-167, “Marrying modern health practices and technology with traditional practices: issues for the African continent” From the preceding examples, the possibilities for collaboration are many. To give direction and impetus to collaboration, traditional practices must first be demystified and legitimized. Demystifying traditional healing begins by separating it from those practices on the other side of the spectrum such as black magic, quackery and witchcraft. These acts are carried out by bogus healers and, according to well-respected traditional healers, are largely responsible for the tarnished image of traditional practitioners. Although traditional healers generally believe that legitimacy comes from the people they serve (), there is consensus among them for their practice to be facilitated and regulated by modern legal processes. Throughout the history of southern Africa, there have been several efforts to discredit traditional healing. In some countries, notably Mozambique, Swaziland, Namibia and South Africa (except for one province), traditional healing has either been prohibited or restricted by law. Legitimacy through coherent national law and policy is thus essential. It will not only legitimize traditional medicine but also restore the credibility of traditional healers. Policy initiated by the World Health Organization (WHO) makes allowance for traditional health care systems and indeed gives impetus for governments to change. When traditional healers are integrated their ideas are incorporated into worldwide western medical thought, giving them international credibility
Dr. M. Akin Makinde, Head of the Department of Philosophy at the University of Ife, Nigeria, and the holder of the Pd.D. in Philosophy of Science from University of Toronto, ‘88 (African Philosophy, Culture, and Traditional Medicine, p. 107) The plan represents a move away from the politics of self-interest inherent in the status quo paradigm of health. This is key to jarring the people of the privileged world out of complacency, establishing a new framework regarding our relationships to other countries and creating a truly level playing field in the area of health access.
Solomon R Benatar, Dept. of Medicine and Bioethics @ Cape Town U and Renee C. Fox, Dept. of Sociology and Center for Bioethics @ Penn U, 2005 (“Meeting Threats to Global Health: a Call for American Leadership,” Perspectives in Biology and Medicine 48.3, p. 344-361) Current and widening disparities in health around the world—even within many countries, including the United States—and the particular plight of Africa during the HIV/AIDS pandemic, together with the implications of new threats from the natural or deliberate spread of infectious diseases (bioterrorism), demonstrate the pressing need for more attention both to moral responsibilities and their underlying values, and to the long-term national interest of wealthy nations in a complex interdependent world. In the visionary words of former President of the Czech Republic, Václav Havel (2002): "If humanity is to survive and avoid new catastrophes, then the global political order has to be accompanied by a sincere and mutual respect among the various spheres of civilization, culture, nations, or continents, and by honest efforts on their part to seek and find the values or basic moral imperatives they have in common, and to build them into the foundations of their coexistence in this globally connected world." Extending the ethics discourse beyond interpersonal relationships to institutional interactions, national approaches to health care, and international relations that have profound effects on population health could help promote the new mindset needed to narrow disparities in health and reduce the potential for new infectious diseases to emerge and rapidly spread globally. Such a mindset requires the realization that health, human rights, economic opportunities, good governance, peace, and development are all intimately linked. The challenges we face in the 21st century are to explore these links, to understand their implications, and to develop processes that could harness economic growth to sustainable human development, progressively narrow global disparities in health, and promote peaceful coexistence (Benatar, Daar, and Singer 2003; Lee, Walt, and Haines 2004). Strategies to effect a new approach to dealing with global health problems will have to address the difficult task of ameliorating constraints that impede the medical profession and other possible change agents from taking an active leadership role in such an effort. These constraints, as we have suggested, include the strong adherence to individualism as a principal cultural value;the types of powerful ideological, political, and economic forces that have perpetuated inequities in access to health care and derailed efforts to develop national health care coverage in the United States; and the fears of many nations about American imperialism. The magnitude and complexity of this task should not be underestimated. Nonetheless, the importance of taking up the challenge also should not be minimized. Privileged people, we believe, need new ways of thinking about the value of the lives of others as well as their own, and about the goals and purposes of medicine and health. Such a requirement cannot be avoided in a world in which almost half the people alive today benefit little if at all from any of the advantages accrued during centuries of progress. New paradigms of thinking and action became vital at various other times in history in the face of profound change, and they are called for again to confront the current threats to human life and security posed by rampant infectious diseases, environmental degradation, and biological terrorism. Those who live, work, and think in rich material and intellectual environments understandably tend to take for granted their wealth, democracy, and civil society (Bethke-Elshtain 1995; Galbraith 1992; Pogge 2001). They may have little direct knowledge or comprehension of how their societies have acquired, and continue to acquire—including through exploitation of distant others—the resources that enable them to lead comfortable lives. They are also remote from the "world of victims" (Farmer 1996, 2003), and from the difficulties faced by colleagues who are endeavoring to sustain universal professional ideals and accessible services in poor, nondemocratic, and oppressive countries, in which a myriad of overt and covert forces influence and obstruct them. The HIV/AIDS pandemic has highlighted some of these issues both in relation to research in developing countries and in making new therapies available to those most in need (Bond 1999; Trouiller, Olliaro, and Torreele 2002). The impact of the SARS epidemic on Toronto was a wake-up call to the fact that privileged societies are not immune to the health, security, and economic threats posed by the emergence and spread of new infectious diseases. As John Kenneth Galbraith (1992) warned many years ago, it is time for privileged people to move beyond self-satisfied complacency. The time is ripe for deep introspection by Americans and other wealthy nations about what they do individually and collectively, and for wider debate about the global impact of the ideology driving highly selfish individualistic behavior. Humility, empathy, and a broad intellectual approach are necessary for several reasons. First, we need to appreciate the pervasiveness of powerful economic and political forces that shaped the past and will shape our future (Donnelly 1989; Falk 1999). Second, this could enable us to better understand the difficulties faced by people in vastly differing societies, and to accept that there is much that can be learned through respect for other cultural perspectives and closer interaction with them. Third, it is necessary to understand that theories and ideas we consider to be universal are to a considerable extent socially constructed and may play out differently in various social and cultural contexts. Finally, we should acknowledge that legitimacy is acquired by those with privilege and power only when they meet their moral obligations to those less fortunate than themselves. Such responsibilities extend beyond merely elaborating universal theories and exhorting others to follow them. Recent human rights abuses at Guantanamo Bay and in the Abu Ghraib prison illustrate how decades of work to promote human rights can be set back by the failure of powerful nations to set an example of the behavior they expect of others. Within the realm of health care, such an introspective approach could deepen our understanding of the extent and depth of conflicts of interest in medical practice and research—a glaring example of which is the pharmaceutical industry's control over global drug prices, which has had markedly adverse effects on the availability of essential drugs in poor countries (Relman and Angell 2001). There is increasing acknowledgement of the need for social justice in the delivery of health care, and escalating urgency both to reclaim much that is being lost in the practice of medicine, and to redefine what is considered necessary for the provision of preventive and curative health care services that meet individual and community needs (Adson 1995; Annas 1995; Buchanan 2001; Lyons 1994; Ste-vens 2001).
Epistemology 1AC BAM! Inherency – Even though traditional healers are held in high regard by the population throughout Africa, post-colonial laws keep them out of the national health systems. In addition, pressure from Western medicine guarantees that this won’t change any time soon.
Erick V. A. Gbodossou, President of PROMETRA (Association For the Promotion of Traditional Medicine) International, Virginia Davis Floyd, Visiting Scholar in Traditional Knowledge Systems at Spelman College and Executive Director of PROMETRA, and Charles Ibnou Katy, coordinator of research and patient services at the Center for Experimental Traditional Medicine, ‘03 ("The Role of Traditional Medicine in Africa’s Fight Against HIV/AIDS," PROMETRA International, www.prometra.org/Documents /AIDSinAfrica-ScenariofortheFut ure.pdf)
Surprisingly, even though the majority of the African population utilizes traditional medicine services, in many African nations traditional medicine technically remains illegal. The World Health Organization’s 2001 survey of the legal status of traditional and complementary/alternative medicine revealed that of the 44 African nations surveyed, 61% had legal statutes regarding traditional medicine. 5 However, even with legal statues in place, national policies have not always been implemented. Often the certifying or authorization mandate is assigned to a local governmental authority without national uniformity. Seventeen nations have local and national councils to address traditional medicine. Varying degrees of involvement with the national health care system are listed. No African nation surveyed provided insurance or financial reimbursement for traditional medicine services. WHO classifies the collaboration between national health care and traditional medicine systems as either integrative, inclusive or tolerant. No African nation exemplifies an integrative system; two (Ghana and Nigeria) are classified as inclusive; the majority fit the description of tolerant systems.In this category the national health care system is based entirely on allopathic medicine, but some TM/CAM practices are tolerated by law. As a legacy of the long history and remnants of European colonization, antiquated laws remain on the books outlawing the practice of traditional medicine. These laws are often overlooked and the practice of traditional medicine is accepted and tolerated throughout the continent. Pressure from organized western medicine also helps to sideline traditional medicine, keeping it out of the policy discussions and specifically out of national health care strategic plans and official systems.
Western medicinal logic embraces an approach to healing that completely separates the body’s wellness from spiritual and mental wellness –this is a scientism that justifies pharmaceutical pillaging, and medicinal/cultural hegemony -
Jo Wredford, researcher at the Aids and Society Research Unit (ASRU) within the Centre for Social Science Research (CSSR) at UCT as well as a Sangoma. 2005, Social Dynamics vol. 31 pg 55-89, “Missing Each Other”, Lexis.
Whether comparisons of ‘popular’ medical beliefs (Feierman, 1985: 112) are valid or not, African and biomedical ontologies, whilst they have common roots, have become fundamentally unlike one another, their dissimilarities resting in their constructions of the causation of ill-health (Horton, 1993: Ch. 7). Traditional African healing draws upon a cosmology of ancestral connections and spiritual power to explain and verify its efficacy (see Beattie, 1966; Horton, 1993; Hountondji, 1997; Noel, 1997; Winch, 1972). The igqirha, for example, considers the human body as part of a cyclical structure, simultaneously social, spiritual, emotional, physical and non-material (Buhrmann, 1984; Feierman, 1992; Iwu, 1986; Janzen, 1992; Ngubane, 1992; Turner, 1992; Willis, 1999). Characterised by a reverence for ancestral authority established through ties of clan and kinship, treatment may involve addressing, and if need be, altering, relationships, both material and spiritual (Gualbert, 1997: 236). To treat the sick in isolation from this ‘ontology of invisible beings’ (Appiah, 1992: 112) – the spiritual community of the ancestors (or indeed, of the living community) – is almost inconceivable (Iwu, 1986; Ngubane, 1977; Yoder, 1982). In contrast, spirituality rarely finds a place in the practice of biomedicine. 5 Western medicine’s inclination to separate mind and spirit from the body encourages the consideration of illness in terms of botched biochemistry (Cunningham and Andrews, 1997: 5-6). The human body becomes a ‘thing’ to be worked on, altered, adjusted, and ultimately (as Margaret Lock’s researches into organ transplants suggests) rebuilt (2002a: 47). As the boundaries of scientific medicine increase, sickness categories tend to increase, until to be healthy seems almost aberrant (Scheper-Hughes, 1987: 26; Harding, 1997: 145); meanwhile behaviourist strictures, somewhat paradoxically, attempt to shore up the utopian ideal of an ‘inalienable right to health’ (Lock, 2002b: 251). The science underpinning biomedical theory and practice, supported by an increasingly powerful and profit-motivated drug industry (Cullet, 2003; Millen and Holtz, 2000; Millen, Lyon and Irwin, 2000), have together appropriated an intellectual and pharmaceutical superiority which is employed to justify biomedicine’s legitimacy as the universal medical model (Ingstad, 1989: 269). This situation certainly applies to the South African medical experience, where the spiritual practices of traditional medicine have at best been expected to live in ‘mute coexistence’ with biomedicine (Hountondji, 1997: 15); running alongside, they are nonetheless marginalised.
This hegemonic control over medicinal knowledge commodifies knowledge and deploys it as power to shape reality and erase traditional medicine and culture from history
Tara W. Lumpkin, Anthropogist with development experience, 2001. “Perceptual Diversity: Is Polyphasic Consciousness Necessary for Global Survival?” Anthropology of Consciousness. Vol. 12, No. 1, pp. 37-70
She adds that reductionism has led to loss of biocomplexity and to "monocultures of the mind" (1995:15). Separation of the knower and knowledge, as well as the union of science and economic power has led to "the creation of monopoly in knowledge, the latest expression of which is 'intellectual property rights'" (Shiva 1995:15). Shiva's linkage of agricultural monoculture to monoculture of the mind is similar to my tenet that there is a need for perceptual diversity. I would also carry the concept of "monoculture" beyond its agricultural meaning into a cultural context by pointing out that as long as development remains a slave to scientism, it will continue to leave in its wake a worldwide monoculture rather than cultural diversity and biocomplexity. Only recently has there been a burgeoning interest among the development community in indigenous knowledge systems and ethnoscience. This interest is primarily found among environmental non-governmental organizations and among community-based resource management planners. The other groups that have shown interest in indigenous knowledge are anthropologists, ethnobotanists, and pharmaceutical companies. Pharmaceutical companies are interested in indigenous knowledge if it leads to "discovering" new chemical compounds to treat disease, which in turn makes them money. There is far less interest in the fact that many traditional healers discovered the medicinal properties of plants by using perceptual modes such as intuition, communication with plants, trance, dreaming, etc. In general, funding for research on perceptual modes is not considered to be the purview of scientific medicine but rather of cultural anthropologists and folklorists. The pharmacology of medicinal plants is deemed "real" because it operates under the rubric of scientism (and can deliver a healthy profit to a pharmaceutical company as well), whereas a traditional healer's transrational process of accessing knowledge about medicinal plants holds little interest for those doling out scientific research and development funds. Sometimes plants are collected to undergo analysis by scientists working for pharmaceutical companies. If a chemical compound is found that might be useful in treating disease, the pharmaceutical company then claims to have "discovered" the active chemical compound in the plant. Pharmaceutical companies can even patent this discovery meaning that the indigenous peoples who have used the plant for years receive no economic benefit from their plant merely because their discovery process was not "scientific." As Michel Foucault (1980) has pointed out, power determines what is knowledge and, hence, what is reality. Until the plant that had been used by indigenous people for years was subjected to a specific methodological analysis, it did not exist and was not "real." Once the plant was discovered via the criteria of scientism, it belonged not to those who had used it for years but to the "discoverer," the person or culture with power.
Western medicine either assimilates or eradicates indigenous healing practices and practitioners in the name of science. Traditional medicine is an ideal point to begin challenging hegemonic discourses
(George J. Sefa Dei, Professor of Sociology, Ontario Institute for Studies in Education, Anthropology and Education Quarterly 1994)
Metaphorically speaking, indigenous Africa is black. For many people in North American societies, “blackness” has also become a political metaphor for identification with the disadvantaged and the ignorant. The Afrocentric discourse contains some uncomfortable truths for some European scholars. With traditional medicine as avalidform of knowledge challenging existing hegemonic, Western discourses concerning scientific medicine become threatened.Eurocentric science perceives indigenous practices as “backward”, “savage”, and “barbaric”. In an era in which the marginalization of African peoples’ experiences and the subjugation of their identities have become more problematic than ever, the devaluation of the spiritual, social, and healing practices of indigenous Africans by Western science has evolved into asystemicdestructionof theircultureandidentityitself. As respected custodians of cultural traditions and knowledge who continually pass on local traditions from one generation to the next, local healers occupy multiple social and political roles central to their society. Privileged as a superior “scientific” system, Western medicine uses its pervasive authority to remove them from these roles by forcing itself on indigenous societies as the only system of knowledge able to “diagnose”, “treat”, and ultimately “cure” the diseases that afflict them.
Western Medicine alone is monophasic – it only accounts for one, static understanding of reality
Tara W. Lumpkin, Anthropogist with development experience, 2001. “Perceptual Diversity: Is Polyphasic Consciousness Necessary for Global Survival?” Anthropology of Consciousness. Vol. 12, No. 1, pp. 37-70
Drawing from personal experience in international development, I not only agree with Walsh but take his theory a few steps further proposing that when a culture restrains perceptual diversity, that same culture reduces human adaptability, which, in turn, leads to human beings living unsustainably. Unsustainable lifestyles result in ecological destruction, including destruction of biodiversity (or biocomplexity). In a feedback loop, degraded environments offer fewer choices to human beings for adaptability, and a downward spiral commences. If, indeed, perceptual diversity promotes human adaptability and indirectly promotes healthy environments, then perceptual diversity has a practical application in everyday life. Yet the value of perceptual diversity is not acknowledged by international development experts, who insist that only a monophasic worldview is valid. In fact, one of the steps to development is for a culture to jettison its perceptual diversity in favor of a specialized approach based on the scientific method and economic progress. The scientific method only acknowledges monophasic consciousness. The method is a specialized system that focuses on studying small and distinctive parts in isolation, which results in fragmented knowledge.
Every action is an affirmation of cultural understandings of knowledge – the 1AC is a particularized defense of our epistemology. The negatives arguments will be a form of knowledge production rather than revelation. Only by releasing knowledge from the culture that gave it birth can we enter into a dialogue to eliminate health inequalities Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007. 194] The dichotomy of knowledge and belief obscures the coexistence of both forms of cultural affirmation in production and adherence to values about learning and sharing. I contend that every accepted form of knowledge is a culturally sanctioned language of belief and of course every belief expresses a particular form of knowledge. I argue that the choice of applying a particular model or theory of behavior amongst a group of academically deified models of behavior is an expression of a belief. In the absence of a universally agreed-upon theory of behavior among the social science theoretical orthodoxy. an expression of belief (choosing one theory over another) tends to be normalized. When knowledge assumes a frame that demands its independence in a form of identity, it also becomes an expression of belief. To insist that one's way of knowing is more relevant to another is a form of a belief deployed through institutions of knowledge production. On the contrary, when a belief opens up to transformation of its possibilities beyond the intellectual and cultural spaces that gave it birth, it becomes a different form of knowledge. Interrogating the interlocking partnership of belief and knowledge in a community has the potential of opening up safe spaces for the community and university, commonly referred to as "Town and Gown," to enter a dialogue on eliminating health inequities, Indeed, much of the university-community research partnership can benefit from embracing an approach that promotes the interplay and interdependency of knowledge and belief. It could also help to move beyond the "Othered" approach that typifies university-community research partnerships, which often has a subtext of a privileged cultural ethos seeking to "help" a disadvantaged cultural space with little or no interest in the identity and collective agency of those who people such disadvantaged cultural spaces.
The affirmation of "Otherness" invoked in the politics of representation also underscores a recognition that Others are torchbearers whose political and educational projects often lead to the discovery of new truths as well as the affirmation of old truths. Quite often, when scholars of oppressed races and nationalities insist that all writing is political, the claim has been dismissed as unscholarly or simply ignored. However, the reality of such claims in public health and health communication has been validated systematically in research on health disparity documents such as the ones produced by the Institute of Medicine reports in 2003 and by the Agency for Healthcare Research and Quality in 2004. Indeed, it is the apolitical analysis of some public health scholars anchored in universal applications that has misguided scholars into assuming acultural, ahistorical, and acontextual approaches to studying health and behavior.
Current models of intervention in Africa that privilege the allopathic perspective increases the health problems of Africans because it fails to take into traditional healers and their unique cultural input Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007. 70]
In spite of efforts to understand cultural values as they relate to personal behaviors, little attention has been given to the development of a culturally appropriate paradigm for health promotion in the African American community. Currently, culturally sensitive educational and behavioral change models for health promotion in African American communities tend to be based primarily on the Caucasian experience. Attempts to make these programs culturally appropriate tend to rely on the individual and family psychology of African Americans. A major shortcoming of these models is the failure to ground personal crises in the social political context within which the individual has to function. It is critical to establish a balance between behavior the individual is capable of changing and the social-political factors in the environment that must be managed before those changes are made and sustained. The outcome is that these approaches offer no models for translating known cultural and institutional realities into a working framework that could guide the development of culturally appropriate health promotion and disease prevention programs in African American communities. There is no doubt that the failure to recognize the cultural inadequacies of traditional models, so as to promote and educate people to use alternative models, has contributed significantly to the profound disparity in health status between African Americans and the White population. Although efforts seem to be commonly focused on the health of poor African Americans, as if they should be held responsible for their economic status and hence a focus on their behavior, much needs to be done about addressing the contextual environment that breeds disparity. Although SES influences health outcomes, racial and cultural oppression are mostly responsible for the low health status of African Americans. Segregation and poor housing have long been established as rQot causes for poor health of African Americans. In the words of Derrick Bell (1992), the inner city is the American equivalent of South African homelands. Low economic status is linked with poor health status, and other factors, such as structural discrimination and institutional racism, favor the disproportionate representation of African Americans in low-income groups, which ultimately results in their poor health status. A focus on individual income fails to address the social context and environment in which a disproportionate number of African Americans find themselves. Even among African Americans whose income levels are the same as those of the majority White population, many other faetors-c-such as total assets, housing, prior SEB, und social IllobiJity- influence health status (Williams and CoJlins20(4).
Thus the plan: The United States Federal Government should provide all necessary funding for the integration of traditional healers into national public health infrastructures in Sub-Saharan Africa. Funding and Enforcement Guaranteed
Integration of traditional medicine is crucial to perceptual diversity and polyphasic understanding– this increases knowledge, biodiversity, cultural diversity, and continued evolution
Tara W. Lumpkin, Anthropogist with development experience, 2001. “Perceptual Diversity: Is Polyphasic Consciousness Necessary for Global Survival?” Anthropology of Consciousness. Vol. 12, No. 1, pp. 37-70 Perceptual diversity allows human beings to access knowledge through a variety of perceptual processes, rather than merely through everyday waking reality. Many of these perceptual processes are transrational altered states of consciousness (meditation, trance, dreams, imagination) and are not considered valid processes for accessing knowledge by science (which is based primarily upon quantification, reductionism, and the experimental method). According to Erika Bourguignon's (1973) research in the 1970s, approximately 90 percent of cultures have institutionalized forms of altered states of consciousness, meaning that such types of consciousness are to be found in most human societies and are "normal." Now, however, transrational consciousness is being devalued in many societies as it is simultaneously being replaced by the monophasic consciousness of "developed" nations. Not only are we are losing (1) biodiversity (biocomplexity) in environments and (2) cultural diversity in societies, we also are losing (3) perceptual diversity in human cognitive processes.All three losses ofdiversity (bio, cultural, and cognitive) are interrelated. Cultures that value perceptual diversity aremore adaptablethan cultures that do not. Perceptually diverse cultures are betterable to understandwhole systems (because they use a variety of perceptual processes to understand systems) thanare cultures that relyonlyon the scientific method, which dissects systems. They also are better stewards of their environments, because theygrasp the valueof the whole of biodiversity (biocomplexity) through transrationalas well asscientific processes. Understanding through perceptual diversity leads to a higher degree of adaptability and evolutionary competence. From the perspective of an anthropologist who has worked with development organizations, development will continue to destroy perceptual diversity because it exports the dominant cognitive process of "developed" nations, i.e., monophasic consciousness. Destroying perceptual diversity, in turn, leads to the destruction of cultural diversity and biocomplexity. Drawing from research I conducted among traditional healers in Namibia, I conclude that development organizationsneed to listento those who use transrational perceptual processes and also need to find a way toincorporateand validate perceptual diversity in their theoretical and applied frameworks.
Integration would bridge the gap create mutual understanding between western and traditional medicine
Dr. M. Akin Makinde, Head of the Department of Philosophy at the University of Ife, Nigeria, and the holder of the Pd.D. in Philosophy of Science from University of Toronto, ‘88 (African Philosophy, Culture, and Traditional Medicine, p. 97-98)
Only by interrogation of assumptions from our privileged status can we properly engage culture and hope for solvency. Our integration project and concurrent acceptance of culture reveals the truth about cultural paradigms and breaks down the often Eurocentric and patriarchal foundations we usually engage in to achieve public health goals. Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007. 195] The discourse on identity and global health is incomplete without the proper anchor on culture. Culture should be central to public health and health promotion intervention strategies in a manner that does not naturally couple the concept of barriers with culture. Intervention projects should draw on the possibilities offered in critical theories that lay bare institutional and Western hegemonies that continue to truncate ef/'(xts to address public health issues in Africa. Stuart Hall ( 1992) notes that cultural hegemony is about imbalance of power, and our responsibility, as echoed by Okri at the beginning of this chapter, is the struggle for a balance of power to achieve the best that our humanity exemplifies in social justice. I have attempted to remap the terrains of conventional theories and cultural logics in health promotion, health communication, and public health by placing them within their particular cultural spaces. By so doing, it is possible to acknowledge that everyone has a culture and that all knowledge production is cultural, and thus all theory is cultural. Such a premise unveils the contextual anchors for theoretical assumptions and praxis so that behaviors are located within cultural spaces. These behaviors are then expressed through different forms of identity as expressed in different behavioral response to health and the lack thereof. What I have attempted in this book is to locate identity and behavior within cultural contexts of health. Thus, it was necessary to challenge existing public health epistemologies by decentering conventional views of health behavior and inserting and centering culture into their theories and practices.
As I have discussed throughout this book, a major requirement in engaging a health and culture project is that we begin with the interrogation of conventional assumptions and classical paradigms and their attendant Eurocentric and often patriarchal foundations. Such interrogation is meant to be a cleansing enterprise that must be engaged in by both the privileged and the marginalized as a liberatory process that allows questioning to become a form of answering. While the privileged interrogate the hegemonic tools of oppression that privilege them, the oppressed and marginalized interrogate their conscious or subconscious participation in promoting ways of knowing that evidently silence their own agency in policies of identity inscribed in the crisis of global health.
The plan represents a move away from the politics of self-interest inherent in the status quo paradigm of health. This is key to jarring the people of the privileged world out of complacency, establishing a new framework regarding our relationships to other countries and creating a truly level playing field in the area of health access.
Solomon R Benatar, Dept. of Medicine and Bioethics @ Cape Town U and Renee C. Fox, Dept. of Sociology and Center for Bioethics @ Penn U, 2005 (“Meeting Threats to Global Health: a Call for American Leadership,” Perspectives in Biology and Medicine 48.3, p. 344-361) Current and widening disparities in health around the world—even within many countries, including the United States—and the particular plight of Africa during the HIV/AIDS pandemic, together with the implications of new threats from the natural or deliberate spread of infectious diseases (bioterrorism), demonstrate the pressing need for more attention both to moral responsibilities and their underlying values, and to the long-term national interest of wealthy nations in a complex interdependent world. In the visionary words of former President of the Czech Republic, Václav Havel (2002): "If humanity is to survive and avoid new catastrophes, then the global political order has to be accompanied by a sincere and mutual respect among the various spheres of civilization, culture, nations, or continents, and by honest efforts on their part to seek and find the values or basic moral imperatives they have in common, and to build them into the foundations of their coexistence in this globally connected world." Extending the ethics discourse beyond interpersonal relationships to institutional interactions, national approaches to health care, and international relations that have profound effects on population health could help promote the new mindset needed to narrow disparities in health and reduce the potential for new infectious diseases to emerge and rapidly spread globally. Such a mindset requires the realization that health, human rights, economic opportunities, good governance, peace, and development are all intimately linked. The challenges we face in the 21st century are to explore these links, to understand their implications, and to develop processes that could harness economic growth to sustainable human development, progressively narrow global disparities in health, and promote peaceful coexistence (Benatar, Daar, and Singer 2003; Lee, Walt, and Haines 2004). Strategies to effect a new approach to dealing with global health problems will have to address the difficult task of ameliorating constraints that impede the medical profession and other possible change agents from taking an active leadership role in such an effort. These constraints, as we have suggested, include the strong adherence to individualism as a principal cultural value;the types of powerful ideological, political, and economic forces that have perpetuated inequities in access to health care and derailed efforts to develop national health care coverage in the United States; and the fears of many nations about American imperialism. The magnitude and complexity of this task should not be underestimated. Nonetheless, the importance of taking up the challenge also should not be minimized. Privileged people, we believe, need new ways of thinking about the value of the lives of others as well as their own, and about the goals and purposes of medicine and health. Such a requirement cannot be avoided in a world in which almost half the people alive today benefit little if at all from any of the advantages accrued during centuries of progress. New paradigms of thinking and action became vital at various other times in history in the face of profound change, and they are called for again to confront the current threats to human life and security posed by rampant infectious diseases, environmental degradation, and biological terrorism. Those who live, work, and think in rich material and intellectual environments understandably tend to take for granted their wealth, democracy, and civil society (Bethke-Elshtain 1995; Galbraith 1992; Pogge 2001). They may have little direct knowledge or comprehension of how their societies have acquired, and continue to acquire—including through exploitation of distant others—the resources that enable them to lead comfortable lives. They are also remote from the "world of victims" (Farmer 1996, 2003), and from the difficulties faced by colleagues who are endeavoring to sustain universal professional ideals and accessible services in poor, nondemocratic, and oppressive countries, in which a myriad of overt and covert forces influence and obstruct them. The HIV/AIDS pandemic has highlighted some of these issues both in relation to research in developing countries and in making new therapies available to those most in need (Bond 1999; Trouiller, Olliaro, and Torreele 2002). The impact of the SARS epidemic on Toronto was a wake-up call to the fact that privileged societies are not immune to the health, security, and economic threats posed by the emergence and spread of new infectious diseases. As John Kenneth Galbraith (1992) warned many years ago, it is time for privileged people to move beyond self-satisfied complacency. The time is ripe for deep introspection by Americans and other wealthy nations about what they do individually and collectively, and for wider debate about the global impact of the ideology driving highly selfish individualistic behavior. Humility, empathy, and a broad intellectual approach are necessary for several reasons. First, we need to appreciate the pervasiveness of powerful economic and political forces that shaped the past and will shape our future (Donnelly 1989; Falk 1999). Second, this could enable us to better understand the difficulties faced by people in vastly differing societies, and to accept that there is much that can be learned through respect for other cultural perspectives and closer
[Benatar/Fox Continued] interaction with them. Third, it is necessary to understand that theories and ideas we consider to be universal are to a considerable extent socially constructed and may play out differently in various social and cultural contexts. Finally, we should acknowledge that legitimacy is acquired by those with privilege and power only when they meet their moral obligations to those less fortunate than themselves. Such responsibilities extend beyond merely elaborating universal theories and exhorting others to follow them. Recent human rights abuses at Guantanamo Bay and in the Abu Ghraib prison illustrate how decades of work to promote human rights can be set back by the failure of powerful nations to set an example of the behavior they expect of others. Within the realm of health care, such an introspective approach could deepen our understanding of the extent and depth of conflicts of interest in medical practice and research—a glaring example of which is the pharmaceutical industry's control over global drug prices, which has had markedly adverse effects on the availability of essential drugs in poor countries (Relman and Angell 2001). There is increasing acknowledgement of the need for social justice in the delivery of health care, and escalating urgency both to reclaim much that is being lost in the practice of medicine, and to redefine what is considered necessary for the provision of preventive and curative health care services that meet individual and community needs (Adson 1995; Annas 1995; Buchanan 2001; Lyons 1994; Ste-vens 2001).
Even though traditional healers are held in high regard by the population throughout Africa, post-colonial laws keep them out of the national health systems. In addition, pressure from Western medicine guarantees that this won’t change any time soon.
Erick V. A. Gbodossou, President of PROMETRA (Association For the Promotion of Traditional Medicine) International, Virginia Davis Floyd, Visiting Scholar in Traditional Knowledge Systems at Spelman College and Executive Director of PROMETRA, and Charles Ibnou Katy, coordinator of research and patient services at the Center for Experimental Traditional Medicine, ‘03 ("The Role of Traditional Medicine in Africa’s Fight Against HIV/AIDS," PROMETRA International, www.prometra.org/Documents /AIDSinAfrica-ScenariofortheFut ure.pdf)
Surprisingly, even though the majority of the African population utilizes traditional medicine services, in many African nations traditional medicine technically remains illegal. The World Health Organization’s 2001 survey of the legal status of traditional and complementary/alternative medicine revealed that of the 44 African nations surveyed, 61% had legal statutes regarding traditional medicine. 5 However, even with legal statues in place, national policies have not always been implemented. Often the certifying or authorization mandate is assigned to a local governmental authority without national uniformity. Seventeen nations have local and national councils to address traditional medicine. Varying degrees of involvement with the national health care system are listed. No African nation surveyed provided insurance or financial reimbursement for traditional medicine services. WHO classifies the collaboration between national health care and traditional medicine systems as either integrative, inclusive or tolerant. No African nation exemplifies an integrative system; two (Ghana and Nigeria) are classified as inclusive; the majority fit the description of tolerant systems. In this category the national health care system is based entirely on allopathic medicine, but some TM/CAM practices are tolerated by law. As a legacy of the long history and remnants of European colonization, antiquated laws remain on the books outlawing the practice of traditional medicine. These laws are often overlooked and the practice of traditional medicine is accepted and tolerated throughout the continent. Pressure from organized western medicine also helps to sideline traditional medicine, keeping it out of the policy discussions and specifically out of national health care strategic plans and official systems.
Lack of medical pluralism creates gaps in infrastructure that inhibits public health programs in Africa
Chidi Oguamanam, Director of Law and Tech Institute @ Dalhousie University, 2006, International Law and Indigenous Knowledge, pg. 9-11
Traditional healers have unique cultural position within society that makes them influential in stopping HIV/AIDS and combating the social stigma associated with AIDS
The Nation June 8, 2007 Friday “Africa Insight - It's Time the West Accepted Africa's Traditional Healers” Lexis
Africa's traditional healers can be most instrumental in HIV and Aids prevention. For starters, these specialists treat most of the cases of STDs and experts believe that STDs are major co-factors in the spread of HIV. Secondly, in developing countries with poor infrastructure, these healers are located in nearly every rural village setting as well as in the busy urban areas. Therefore, they are a godsend to Africa's cash-strapped health ministries since they are already "on the ground". Traditional healers in Africa are also quite knowledgeable about HIV and Aids. For example, urban traditional healers in Tanzania know very well about the opportunistic infections caused by HIV and Aids and what herbal medicines can treat them. They know too that a healthy diet and treatment of sexually transmittable diseases can greatly help in maintaining good health for PLWHAs besides keeping HIV-infection at bay. Furthermore, they are also aware that high fevers from malaria, for instance, can weaken the body even further if one is HIV-positive. They also tell their patients not to engage in sexual activity because it cannot only further the spread the virus but also weaken their immune system. Even something as simple as a massage can have great physical and psychological benefits since it both relieves PLWHAs of excruciating pains in their lower limbs but it also gives them existential reassurance since they know that few want to touch someone with HIV and Aids. Simply dishing out ARVs is not enough. PLWHAs in Africa need appropriate social counselling and "pyschic" support and indigenous healers can provide the appropriate emotional, psychological, spiritual counselling. For example, such counselling would deal with reducing social stigmatization (something that even PLWHAs in the West continue to experience but is offered little help from Western biomedicine and social services.
AIDS stigmatization creates a culture of silence that discourages treatment fueling a ticking time bomb -
JM Spectar, Ph.D "The Hydra Hath But One Head: the socio-cultural dimensions of the AIDS epidemic and women's right to health" Boston College Third World Law Journal, Winter 2001, p. lexis
In addition, some women with AIDS are not only denied access to health care, jobs, and housing, but are "even murdered." **46** UNAIDS reports that "women who are often monogamous wives infected by their husbands are especially stigmatized." 47 Women with HIV are often "blamed by their in-laws for the fate of their infected spouse, even in cases when they themselves are not infected." 48 Sometimes, when a man dies of AIDS, his spouse "risks being thrown out of her home by her in-laws, often losing her children in the process." 49 A recent study by the Food and Agriculture Organization (FAO) in Namibia found "gender bias" in the treatment of women with AIDS: households headed by HIV-infected women generally lose their livestock, "thus jeopardizing the food and security of surviving members." 50 During an official trip to Africa, U.S. Ambassador Richard Holbrooke spoke poignantly of a visit with six HIV-infected pregnant women in Wind-hoek, Namibia, who had met with the U.S. delegation clandestinely because of the stigmatization and shame linked with the disease: These women told us that if they even admitted their ailment, they would lose their husbands and families, their jobs, and are completely ostracized from society. Under such circumstances, these women are simply left to die. . . . In too many places, families (and many doctors) even refuse to recognize AIDS as a cause of death. Often, they'll cover it up by attributing death to AIDS-related illnesses like pneumonia. **51** [*9] The stigmatization of AIDS further lessens the likelihood of its successful prevention or treatment because many at-risk persons might be "discouraged from obtaining the necessary information, goods and services for self-protection." **52** If women with AIDS face rejection and other violations of their human rights, women who suspect they are HIV-infected may avoid getting tested and may be disinclined to take "precautionary measures with their partners, for fear of revealing their infection; they may even avoid seeking health care." 53 The silence surrounding AIDS creates "a pandemic time-bomb waiting to explode," especially in areas of the developing world where most infected persons do not even know they are infected. 54 UNAIDS reports that in countries such as India, "the association between HIV and promiscuous sexual behaviour has created a belief that people who are infected with HIV somehow deserve their fate." __55__ The stigmatization of AIDS as a moral failing often fuels a syndrome of silence that, in turn, places many women and young girls in further jeopardy.
Unchecked AIDS will cause extinction.
Muchiri, 2K
(Jakarta Post, March 6, Lexis)
There is no doubt that AIDS is the most serious threat to humankind, more serious than hurricanes, earthquakes, economic crises, capital crashes or floods. It has no cure yet. We are watching a whole continent degenerate into ghostly skeletons that finally succumb to a most excruciating, dehumanizing death. Gore said that his new initiative, if approved by the U.S. Congress, would bring U.S. contributions to fighting AIDS and other infectious diseases to $ 325 million. Does this mean that the UN Security Council and the U.S. in particular have at last decided to remember Africa? Suddenly, AIDS was seen as threat to world peace, and Gore would ask the congress to set up millions of dollars on this case. The hope is that Gore does not intend to make political capital out of this by painting the usually disagreeable Republican-controlled Congress as the bad guy and hope the buck stops on the whole of current and future U.S. governments' conscience. Maybe there is nothing left to salvage in Africa after all and this talk is about the African-American vote in November's U.S. presidential vote. Although the UN and the Security Council cannot solve all African problems, the AIDS challenge is a fundamental one in that it threatens to wipe out man. The challenge is not one of a single continent alone because Africa cannot be quarantined. The trouble is that AIDS has no cure -- and thus even the West has stakes in the AIDS challenge. Once sub-Saharan Africa is wiped out, it shall not be long before another continent is on the brink of extinction. Sure as death, Africa's time has run out, signaling the beginning of the end of the black race and maybe the human race.
Contention 2 is Cultural Genocide:
Traditional Healers are the primary agent holding together indigenous cultures in Sub-Saharan Africa.
Puckree Department of Physiotherapy @ University of Durban, 2002, International Journal of Rehabilitation Research, Lexis
Traditional healing has been an integral but unrecognized component of the South African health care system. In recent years it has been receiving increasing attention and recognition as a vital component of the primary health care system. It has been legislated for and traditional healers can apply for licences and now call themselves ‘doctors’. As many as 400 000 recognized traditional healers serve health care in South Africa (Gumbi, 1996). The number of ‘quack’ traditional healers exceeds this number. Gumbi (1996) stated that 60–80% of the African population regularly utilizes the services of traditional healers. The number of Western-style doctors and health care personnel in the province of Kwa-Zulu Natal or South Africa is too small to meet the actual health care needs of the province and country. In order to rationalize and make health care accessible to all, and cost effective, there must be an integration and rationalization of health care providers regardless of whether they are traditionally or Western trained. In order to achieve this aim, Western-trained health care professionals need to know the exact role of the traditional healer in the provision of heath care in the province. Culturally, the traditional healer plays an intrinsic role in a patient's life and in the community in which they live. Illnesses perceived to be of supernatural origin are managed together with their physical manifestations so that the patient feels as if they have been treated holistically. The African patient has mostly used Western medicine to supplement the traditional healers' services or as a last resort (Gumbi, 1996). Western-trained health care practitioners ignore these facts. Despite this, some traditional herbal medicines are now being scientifically evaluated and validated. There are three categories of African traditional healers in South Africa. The Izinyangas are the herbalists who use herbs and other preparations for treating diseases. The Sangomas operate within a religious supernatural context. The faith healers' health care integrates Christian ritual and traditional practices (Pretorius, 2001). Traditional healing has found a recognized niche in the health care system and the national government has legislated a rationalized system of health care to deliver services to all its citizens. Therefore it is vital for physiotherapists and other health care professionals to understand, evaluate and embrace these health care practitioners to provide safe evidence-based care to the community. The purpose of the present study was to determine the role of traditional healers in Durban, the number of patients who consulted traditional healers, the types of conditions treated and the frequency of consul-tations. The opinions about physiotherapy of the patients who frequently consult traditional healers were also explored.
Culture is Key to Identity
Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007.]
The study of culture is shrouded in identity politics. Culture is so much a part of identity that the two words are often coupled to produce cultural identity. What is certain is that for identity to have meaning, it is directly or indirectly associated with culture. The meanings that are ascribed to one's group identity, therefore, have a strong historical and social meaning that goes beyond individual choice of identity. For example, knowing one's racial or ethnic identity in the United States and South Africa reveals more of the societal arrangements and identity politics than any text of individual understanding of one's biological being. It is the strength and salience of social arrangements, often anchored in the politics of difference, that necessitate a globally relevant and inclusive definition of group identity-culture. Culture is what defines our identity. Even when we claim dual or multiple cultures, our primary culture of reference is where we seek refuge in times of difficulty.
Contention 3 is Biodiversity:
The Western approach to medicine leads to the destruction of biodiversity
Chidi Oguamanam, Director of Law and Tech Institute @ Dalhousie University, 2006, International Law and Indigenous Knowledge, pg. 53-54
Thus the plan: The United States Federal Government should provide all nessecary funding for the integration of traditional healers into national public health infrastructures in Sub-Saharan Africa.
Funding and Enforcement Guaranteed
Contention 4 is Solvency:
Integration of traditional medicine is crucial to perceptual diversity – this increases knowledge, biodiversity, cultural diversity, and continued evolution
Tara W. Lumpkin, Anthropogist with development experience, 2001. “Perceptual Diversity: Is Polyphasic Consciousness Necessary for Global Survival?” Anthropology of Consciousness. Vol. 12, No. 1, pp. 37-70
Perceptual diversity allows human beings to access knowledge through a variety of perceptual processes, rather than merely through everyday waking reality. Many of these perceptual processes are transrational altered states of consciousness (meditation, trance, dreams, imagination) and are not considered valid processes for accessing knowledge by science (which is based primarily upon quantification, reductionism, and the experimental method). According to Erika Bourguignon's (1973) research in the 1970s, approximately 90 percent of cultures have institutionalized forms of altered states of consciousness, meaning that such types of consciousness are to be found in most human societies and are "normal." Now, however, transrational consciousness is being devalued in many societies as it is simultaneously being replaced by the monophasic consciousness of "developed" nations. Not only are we are losing (1) biodiversity (biocomplexity) in environments and (2) cultural diversity in societies, we also are losing (3) perceptual diversity in human cognitive processes. All three losses of diversity (bio, cultural, and cognitive) are interrelated. Cultures that value perceptual diversity are more adaptable than cultures that do not. Perceptually diverse cultures are better able to understand whole systems (because they use a variety of perceptual processes to understand systems) than are cultures that rely only on the scientific method, which dissects systems. They also are better stewards of their environments, because they grasp the value of the whole of biodiversity (biocomplexity) through transrational as well as scientific processes. Understanding through perceptual diversity leads to a higher degree of adaptability and evolutionary competence. From the perspective of an anthropologist who has worked with development organizations, development will continue to destroy perceptual diversity because it exports the dominant cognitive process of "developed" nations, i.e., monophasic consciousness. Destroying perceptual diversity, in turn, leads to the destruction of cultural diversity and biocomplexity. Drawing from research I conducted among traditional healers in Namibia, I conclude that development organizations need to listen to those who use transrational perceptual processes and also need to find a way to incorporate and validate perceptual diversity in their theoretical and applied frameworks.
Problems in Africa’s health system could be solved by an integration of traditional healers. Healers reach those whom are overlooked by western medicine, are easily capable of gaining trust of patients, and provide psychological help to patients
Saajk Van der Geest, Medical Anthropology Professor @ University of Amsterdam, 1997, Tropical Medicine and International Health, Volume 2, No. 9, pg 903-910
Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007. 195]
The discourse on identity and global health is incomplete without the proper anchor on culture. Culture should be central to public health and health promotion intervention strategies in a manner that does not naturally couple the concept of barriers with culture. Intervention projects should draw on the possibilities offered in critical theories that lay bare institutional and Western hegemonies that continue to truncate ef/'(xts to address public health issues in Africa. Stuart Hall ( 1992) notes that cultural hegemony is about imbalance of power, and our responsibility, as echoed by Okri at the beginning of this chapter, is the struggle for a balance of power to achieve the best that our humanity exemplifies in social justice.
I have attempted to remap the terrains of conventional theories and cultural logics in health promotion, health communication, and public health by placing them within their particular cultural spaces. By so doing, it is possible to acknowledge that everyone has a culture and that all knowledge production is cultural, and thus all theory is cultural. Such a premise unveils the contextual anchors for theoretical assumptions and praxis so that behaviors are located within cultural spaces. These behaviors are then expressed through different forms of identity as expressed in different behavioral response to health and the lack thereof. What I have attempted in this book is to locate identity and behavior within cultural contexts of health. Thus, it was necessary to challenge existing public health epistemologies by decentering conventional views of health behavior and inserting and centering culture into their theories and practices.
As I have discussed throughout this book, a major requirement in engaging a health and culture project is that we begin with the interrogation of conventional assumptions and classical paradigms and their attendant Eurocentric and often patriarchal foundations. Such interrogation is meant to be a cleansing enterprise that must be engaged in by both the privileged and the marginalized as a liberatory process that allows questioning to become a form of answering. While the privileged interrogate the hegemonic tools of oppression that privilege them, the oppressed and marginalized interrogate their conscious or subconscious participation in promoting ways of knowing that evidently silence their own agency in policies of identity inscribed in the crisis of global health.
US action is key-- United States health policies are modeled around the world and we have a moral obligation to advance public health
.
Dr. Solomon R. Benatar, Department of Sociology and Center for Bioethics, University of Pennsylvania. 2005 Meeting Threats to Global Health: A Call for American Leadership. Correspondence. Summer.]
This paper, by a South African physician and an American medical sociologist, considers challenges that face global health, health care professionals, and governments at the beginning of the 21st century. Our reflections rest on three major premises: that global health problems pose major medical, social, and economic threats to all countries; that it is in the long-term self-interest of wealthy nations to address the forces that significantly affect the health of whole populations; and that at this historical juncture, the United States is the country with the most potential for favorably influencing global health trends. In addition to discussing the nature of threats to global health, we explore some of the major impediments to efforts that could be undertaken to foster alterations in policies that would effectively address the tragic discrepancies in health care and research that currently exist, and to overcome global apathy to the HIV/AIDS pandemic (Hogg et al. 2002). These obstacles involve a confluence of important American values, exemplified by political ideologies that have global as well as national health import; the prevailing ethos of bioethics in the United States; and the current views of many other countries towards the international policies and actions of the United States.
As sociologist Robert N. Bellah (2002) has provocatively stated, in and through the "relentless" process of globalization, the United States has become a "cultural model and economic dynamo" as well as a military superpower, and more "by default" than by intention, a country with "imperial power." In our view, because of its singularity in these respects (for better or for worse), the United States not only has the scientific, political, and economic capacity to assume major responsibility for improving world health, but also the moral obligation to exemplify and implement values in action that are conducive to this advancement. We make this statement with two caveats. First, we are wary about [End Page 345] unduly promoting the dominance of American influence in the world by encouraging its moral hegemony in global health. Second, as noted above, we are mindful of the cultural and political factors that curtail the readiness and willingness of the United States to assume such a leadership role, and that contribute to health inequities in the American health care system that call for reform rather than emulation. We believe, however, that these caveats should be superseded by the moral imperative of facing up to national and global threats posed by disparities in health and emerging epidemics. Moreover, we believe that the long-term interests of Americans, and indeed of all privileged people and their societies, will be served by major improvements in global health (Benatar 2003). (…)
"The way medicine is practiced in the United States has a strong influence on the rest of the world, for better or for worse," a Swiss physician has written (Mosimann 2002).
US action to integrate healers gives traditional medicine the legitimacy that is critical to acceptance by the allopathic community
International Nursing Review, September 2002, Volume 49, Issue 3, Page 161-167, “Marrying modern health practices and technology with traditional practices: issues for the African continent”
From the preceding examples, the possibilities for collaboration are many. To give direction and impetus to collaboration, traditional practices must first be demystified and legitimized. Demystifying traditional healing begins by separating it from those practices on the other side of the spectrum such as black magic, quackery and witchcraft. These acts are carried out by bogus healers and, according to well-respected traditional healers, are largely responsible for the tarnished image of traditional practitioners. Although traditional healers generally believe that legitimacy comes from the people they serve (), there is consensus among them for their practice to be facilitated and regulated by modern legal processes. Throughout the history of southern Africa, there have been several efforts to discredit traditional healing. In some countries, notably Mozambique, Swaziland, Namibia and South Africa (except for one province), traditional healing has either been prohibited or restricted by law. Legitimacy through coherent national law and policy is thus essential. It will not only legitimize traditional medicine but also restore the credibility of traditional healers. Policy initiated by the World Health Organization (WHO) makes allowance for traditional health care systems and indeed gives impetus for governments to change.
When traditional healers are integrated their ideas are incorporated into worldwide western medical thought, giving them international credibility
Dr. M. Akin Makinde, Head of the Department of Philosophy at the University of Ife, Nigeria, and the holder of the Pd.D. in Philosophy of Science from University of Toronto, ‘88 (African Philosophy, Culture, and Traditional Medicine, p. 107)
The plan represents a move away from the politics of self-interest inherent in the status quo paradigm of health. This is key to jarring the people of the privileged world out of complacency, establishing a new framework regarding our relationships to other countries and creating a truly level playing field in the area of health access.
Solomon R Benatar, Dept. of Medicine and Bioethics @ Cape Town U and Renee C. Fox, Dept. of Sociology and Center for Bioethics @ Penn U, 2005 (“Meeting Threats to Global Health: a Call for American Leadership,” Perspectives in Biology and Medicine 48.3, p. 344-361)
Current and widening disparities in health around the world—even within many countries, including the United States—and the particular plight of Africa during the HIV/AIDS pandemic, together with the implications of new threats from the natural or deliberate spread of infectious diseases (bioterrorism), demonstrate the pressing need for more attention both to moral responsibilities and their underlying values, and to the long-term national interest of wealthy nations in a complex interdependent world. In the visionary words of former President of the Czech Republic, Václav Havel (2002): "If humanity is to survive and avoid new catastrophes, then the global political order has to be accompanied by a sincere and mutual respect among the various spheres of civilization, culture, nations, or continents, and by honest efforts on their part to seek and find the values or basic moral imperatives they have in common, and to build them into the foundations of their coexistence in this globally connected world." Extending the ethics discourse beyond interpersonal relationships to institutional interactions, national approaches to health care, and international relations that have profound effects on population health could help promote the new mindset needed to narrow disparities in health and reduce the potential for new infectious diseases to emerge and rapidly spread globally. Such a mindset requires the realization that health, human rights, economic opportunities, good governance, peace, and development are all intimately linked. The challenges we face in the 21st century are to explore these links, to understand their implications, and to develop processes that could harness economic growth to sustainable human development, progressively narrow global disparities in health, and promote peaceful coexistence (Benatar, Daar, and Singer 2003; Lee, Walt, and Haines 2004). Strategies to effect a new approach to dealing with global health problems will have to address the difficult task of ameliorating constraints that impede the medical profession and other possible change agents from taking an active leadership role in such an effort. These constraints, as we have suggested, include the strong adherence to individualism as a principal cultural value; the types of powerful ideological, political, and economic forces that have perpetuated inequities in access to health care and derailed efforts to develop national health care coverage in the United States; and the fears of many nations about American imperialism. The magnitude and complexity of this task should not be underestimated. Nonetheless, the importance of taking up the challenge also should not be minimized. Privileged people, we believe, need new ways of thinking about the value of the lives of others as well as their own, and about the goals and purposes of medicine and health. Such a requirement cannot be avoided in a world in which almost half the people alive today benefit little if at all from any of the advantages accrued during centuries of progress. New paradigms of thinking and action became vital at various other times in history in the face of profound change, and they are called for again to confront the current threats to human life and security posed by rampant infectious diseases, environmental degradation, and biological terrorism. Those who live, work, and think in rich material and intellectual environments understandably tend to take for granted their wealth, democracy, and civil society (Bethke-Elshtain 1995; Galbraith 1992; Pogge 2001). They may have little direct knowledge or comprehension of how their societies have acquired, and continue to acquire—including through exploitation of distant others—the resources that enable them to lead comfortable lives. They are also remote from the "world of victims" (Farmer 1996, 2003), and from the difficulties faced by colleagues who are endeavoring to sustain universal professional ideals and accessible services in poor, nondemocratic, and oppressive countries, in which a myriad of overt and covert forces influence and obstruct them. The HIV/AIDS pandemic has highlighted some of these issues both in relation to research in developing countries and in making new therapies available to those most in need (Bond 1999; Trouiller, Olliaro, and Torreele 2002). The impact of the SARS epidemic on Toronto was a wake-up call to the fact that privileged societies are not immune to the health, security, and economic threats posed by the emergence and spread of new infectious diseases. As John Kenneth Galbraith (1992) warned many years ago, it is time for privileged people to move beyond self-satisfied complacency. The time is ripe for deep introspection by Americans and other wealthy nations about what they do individually and collectively, and for wider debate about the global impact of the ideology driving highly selfish individualistic behavior. Humility, empathy, and a broad intellectual approach are necessary for several reasons. First, we need to appreciate the pervasiveness of powerful economic and political forces that shaped the past and will shape our future (Donnelly 1989; Falk 1999). Second, this could enable us to better understand the difficulties faced by people in vastly differing societies, and to accept that there is much that can be learned through respect for other cultural perspectives and closer interaction with them. Third, it is necessary to understand that theories and ideas we consider to be universal are to a considerable extent socially constructed and may play out differently in various social and cultural contexts. Finally, we should acknowledge that legitimacy is acquired by those with privilege and power only when they meet their moral obligations to those less fortunate than themselves. Such responsibilities extend beyond merely elaborating universal theories and exhorting others to follow them. Recent human rights abuses at Guantanamo Bay and in the Abu Ghraib prison illustrate how decades of work to promote human rights can be set back by the failure of powerful nations to set an example of the behavior they expect of others. Within the realm of health care, such an introspective approach could deepen our understanding of the extent and depth of conflicts of interest in medical practice and research—a glaring example of which is the pharmaceutical industry's control over global drug prices, which has had markedly adverse effects on the availability of essential drugs in poor countries (Relman and Angell 2001). There is increasing acknowledgement of the need for social justice in the delivery of health care, and escalating urgency both to reclaim much that is being lost in the practice of medicine, and to redefine what is considered necessary for the provision of preventive and curative health care services that meet individual and community needs (Adson 1995; Annas 1995; Buchanan 2001; Lyons 1994; Ste-vens 2001).
Epistemology 1AC
BAM! Inherency –
Even though traditional healers are held in high regard by the population throughout Africa, post-colonial laws keep them out of the national health systems. In addition, pressure from Western medicine guarantees that this won’t change any time soon.
Erick V. A. Gbodossou, President of PROMETRA (Association For the Promotion of Traditional Medicine) International, Virginia Davis Floyd, Visiting Scholar in Traditional Knowledge Systems at Spelman College and Executive Director of PROMETRA, and Charles Ibnou Katy, coordinator of research and patient services at the Center for Experimental Traditional Medicine, ‘03 ("The Role of Traditional Medicine in Africa’s Fight Against HIV/AIDS," PROMETRA International, www.prometra.org/Documents /AIDSinAfrica-ScenariofortheFut ure.pdf)
Surprisingly, even though the majority of the African population utilizes traditional medicine services, in many African nations traditional medicine technically remains illegal. The World Health Organization’s 2001 survey of the legal status of traditional and complementary/alternative medicine revealed that of the 44 African nations surveyed, 61% had legal statutes regarding traditional medicine. 5 However, even with legal statues in place, national policies have not always been implemented. Often the certifying or authorization mandate is assigned to a local governmental authority without national uniformity. Seventeen nations have local and national councils to address traditional medicine. Varying degrees of involvement with the national health care system are listed. No African nation surveyed provided insurance or financial reimbursement for traditional medicine services. WHO classifies the collaboration between national health care and traditional medicine systems as either integrative, inclusive or tolerant. No African nation exemplifies an integrative system; two (Ghana and Nigeria) are classified as inclusive; the majority fit the description of tolerant systems. In this category the national health care system is based entirely on allopathic medicine, but some TM/CAM practices are tolerated by law. As a legacy of the long history and remnants of European colonization, antiquated laws remain on the books outlawing the practice of traditional medicine. These laws are often overlooked and the practice of traditional medicine is accepted and tolerated throughout the continent. Pressure from organized western medicine also helps to sideline traditional medicine, keeping it out of the policy discussions and specifically out of national health care strategic plans and official systems.
Western medicinal logic embraces an approach to healing that completely separates the body’s wellness from spiritual and mental wellness –this is a scientism that justifies pharmaceutical pillaging, and medicinal/cultural hegemony -
Jo Wredford, researcher at the Aids and Society Research Unit (ASRU) within the Centre for Social Science Research (CSSR) at UCT as well as a Sangoma. 2005, Social Dynamics vol. 31 pg 55-89, “Missing Each Other”, Lexis.
Whether comparisons of ‘popular’ medical beliefs (Feierman, 1985: 112) are valid or not, African and biomedical ontologies, whilst they have common roots, have become fundamentally unlike one another, their dissimilarities resting in their constructions of the causation of ill-health (Horton, 1993: Ch. 7). Traditional African healing draws upon a cosmology of ancestral connections and spiritual power to explain and verify its efficacy (see Beattie, 1966; Horton, 1993; Hountondji, 1997; Noel, 1997; Winch, 1972). The igqirha, for example, considers the human body as part of a cyclical structure, simultaneously social, spiritual, emotional, physical and non-material (Buhrmann, 1984; Feierman, 1992; Iwu, 1986; Janzen, 1992; Ngubane, 1992; Turner, 1992; Willis, 1999). Characterised by a reverence for ancestral authority established through ties of clan and kinship, treatment may involve addressing, and if need be, altering, relationships, both material and spiritual (Gualbert, 1997: 236). To treat the sick in isolation from this ‘ontology of invisible beings’ (Appiah, 1992: 112) – the spiritual community of the ancestors (or indeed, of the living community) – is almost inconceivable (Iwu, 1986; Ngubane, 1977; Yoder, 1982). In contrast, spirituality rarely finds a place in the practice of biomedicine. 5 Western medicine’s inclination to separate mind and spirit from the body encourages the consideration of illness in terms of botched biochemistry (Cunningham and Andrews, 1997: 5-6). The human body becomes a ‘thing’ to be worked on, altered, adjusted, and ultimately (as Margaret Lock’s researches into organ transplants suggests) rebuilt (2002a: 47). As the boundaries of scientific medicine increase, sickness categories tend to increase, until to be healthy seems almost aberrant (Scheper-Hughes, 1987: 26; Harding, 1997: 145); meanwhile behaviourist strictures, somewhat paradoxically, attempt to shore up the utopian ideal of an ‘inalienable right to health’ (Lock, 2002b: 251). The science underpinning biomedical theory and practice, supported by an increasingly powerful and profit-motivated drug industry (Cullet, 2003; Millen and Holtz, 2000; Millen, Lyon and Irwin, 2000), have together appropriated an intellectual and pharmaceutical superiority which is employed to justify biomedicine’s legitimacy as the universal medical model (Ingstad, 1989: 269). This situation certainly applies to the South African medical experience, where the spiritual practices of traditional medicine have at best been expected to live in ‘mute coexistence’ with biomedicine (Hountondji, 1997: 15); running alongside, they are nonetheless marginalised.
This hegemonic control over medicinal knowledge commodifies knowledge and deploys it as power to shape reality and erase traditional medicine and culture from history
Tara W. Lumpkin, Anthropogist with development experience, 2001. “Perceptual Diversity: Is Polyphasic Consciousness Necessary for Global Survival?” Anthropology of Consciousness. Vol. 12, No. 1, pp. 37-70
She adds that reductionism has led to loss of biocomplexity and to "monocultures of the mind" (1995:15). Separation of the knower and knowledge, as well as the union of science and economic power has led to "the creation of monopoly in knowledge, the latest expression of which is 'intellectual property rights'" (Shiva 1995:15). Shiva's linkage of agricultural monoculture to monoculture of the mind is similar to my tenet that there is a need for perceptual diversity. I would also carry the concept of "monoculture" beyond its agricultural meaning into a cultural context by pointing out that as long as development remains a slave to scientism, it will continue to leave in its wake a worldwide monoculture rather than cultural diversity and biocomplexity. Only recently has there been a burgeoning interest among the development community in indigenous knowledge systems and ethnoscience. This interest is primarily found among environmental non-governmental organizations and among community-based resource management planners. The other groups that have shown interest in indigenous knowledge are anthropologists, ethnobotanists, and pharmaceutical companies. Pharmaceutical companies are interested in indigenous knowledge if it leads to "discovering" new chemical compounds to treat disease, which in turn makes them money. There is far less interest in the fact that many traditional healers discovered the medicinal properties of plants by using perceptual modes such as intuition, communication with plants, trance, dreaming, etc. In general, funding for research on perceptual modes is not considered to be the purview of scientific medicine but rather of cultural anthropologists and folklorists. The pharmacology of medicinal plants is deemed "real" because it operates under the rubric of scientism (and can deliver a healthy profit to a pharmaceutical company as well), whereas a traditional healer's transrational process of accessing knowledge about medicinal plants holds little interest for those doling out scientific research and development funds. Sometimes plants are collected to undergo analysis by scientists working for pharmaceutical companies. If a chemical compound is found that might be useful in treating disease, the pharmaceutical company then claims to have "discovered" the active chemical compound in the plant. Pharmaceutical companies can even patent this discovery meaning that the indigenous peoples who have used the plant for years receive no economic benefit from their plant merely because their discovery process was not "scientific." As Michel Foucault (1980) has pointed out, power determines what is knowledge and, hence, what is reality. Until the plant that had been used by indigenous people for years was subjected to a specific methodological analysis, it did not exist and was not "real." Once the plant was discovered via the criteria of scientism, it belonged not to those who had used it for years but to the "discoverer," the person or culture with power.
Western medicine either assimilates or eradicates indigenous healing practices and practitioners in the name of science. Traditional medicine is an ideal point to begin challenging hegemonic discourses
(George J. Sefa Dei, Professor of Sociology, Ontario Institute for Studies in Education, Anthropology and Education Quarterly 1994)
Metaphorically speaking, indigenous Africa is black. For many people in North American societies, “blackness” has also become a political metaphor for identification with the disadvantaged and the ignorant. The Afrocentric discourse contains some uncomfortable truths for some European scholars. With traditional medicine as a valid form of knowledge challenging existing hegemonic, Western discourses concerning scientific medicine become threatened. Eurocentric science perceives indigenous practices as “backward”, “savage”, and “barbaric”. In an era in which the marginalization of African peoples’ experiences and the subjugation of their identities have become more problematic than ever, the devaluation of the spiritual, social, and healing practices of indigenous Africans by Western science has evolved into a systemic destruction of their culture and identity itself. As respected custodians of cultural traditions and knowledge who continually pass on local traditions from one generation to the next, local healers occupy multiple social and political roles central to their society. Privileged as a superior “scientific” system, Western medicine uses its pervasive authority to remove them from these roles by forcing itself on indigenous societies as the only system of knowledge able to “diagnose”, “treat”, and ultimately “cure” the diseases that afflict them.
Western Medicine alone is monophasic – it only accounts for one, static understanding of reality
Tara W. Lumpkin, Anthropogist with development experience, 2001. “Perceptual Diversity: Is Polyphasic Consciousness Necessary for Global Survival?” Anthropology of Consciousness. Vol. 12, No. 1, pp. 37-70
Drawing from personal experience in international development, I not only agree with Walsh but take his theory a few steps further proposing that when a culture restrains perceptual diversity, that same culture reduces human adaptability, which, in turn, leads to human beings living unsustainably. Unsustainable lifestyles result in ecological destruction, including destruction of biodiversity (or biocomplexity). In a feedback loop, degraded environments offer fewer choices to human beings for adaptability, and a downward spiral commences. If, indeed, perceptual diversity promotes human adaptability and indirectly promotes healthy environments, then perceptual diversity has a practical application in everyday life. Yet the value of perceptual diversity is not acknowledged by international development experts, who insist that only a monophasic worldview is valid. In fact, one of the steps to development is for a culture to jettison its perceptual diversity in favor of a specialized approach based on the scientific method and economic progress. The scientific method only acknowledges monophasic consciousness. The method is a specialized system that focuses on studying small and distinctive parts in isolation, which results in fragmented knowledge.
Every action is an affirmation of cultural understandings of knowledge – the 1AC is a particularized defense of our epistemology. The negatives arguments will be a form of knowledge production rather than revelation. Only by releasing knowledge from the culture that gave it birth can we enter into a dialogue to eliminate health inequalities
Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007. 194]
The dichotomy of knowledge and belief obscures the coexistence of both forms of cultural affirmation in production and adherence to values about learning and sharing. I contend that every accepted form of knowledge is a culturally sanctioned language of belief and of course every belief expresses a particular form of knowledge. I argue that the choice of applying a particular model or theory of behavior amongst a group of academically deified models of behavior is an expression of a belief. In the absence of a universally agreed-upon theory of behavior among the social science theoretical orthodoxy. an expression of belief (choosing one theory over another) tends to be normalized.
When knowledge assumes a frame that demands its independence in a form of identity, it also becomes an expression of belief. To insist that one's way of knowing is more relevant to another is a form of a belief deployed through institutions of knowledge production. On the contrary, when a belief opens up to transformation of its possibilities beyond the intellectual and cultural spaces that gave it birth, it becomes a different form of knowledge. Interrogating the interlocking partnership of belief and knowledge in a community has the potential of opening up safe spaces for the community and university, commonly referred to as "Town and Gown," to enter a dialogue on eliminating health inequities, Indeed, much of the university-community research partnership can benefit from embracing an approach that promotes the interplay and interdependency of knowledge and belief. It could also help to move beyond the "Othered" approach that typifies university-community research partnerships, which often has a subtext of a privileged cultural ethos seeking to "help" a disadvantaged cultural space with little or no interest in the identity and collective agency of those who people such disadvantaged cultural spaces.
The affirmation of "Otherness" invoked in the politics of representation also underscores a recognition that Others are torchbearers whose political and educational projects often lead to the discovery of new truths as well as the affirmation of old truths. Quite often, when scholars of oppressed races and nationalities insist that all writing is political, the claim has been dismissed as unscholarly or simply ignored. However, the reality of such claims in public health and health communication has been validated systematically in research on health disparity documents such as the ones produced by the Institute of Medicine reports in 2003 and by the Agency for Healthcare Research and Quality in 2004. Indeed, it is the apolitical analysis of some public health scholars anchored in universal applications that has misguided scholars into assuming acultural, ahistorical, and acontextual approaches to studying health and behavior.
Current models of intervention in Africa that privilege the allopathic perspective increases the health problems of Africans because it fails to take into traditional healers and their unique cultural input
Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007. 70]
In spite of efforts to understand cultural values as they relate to personal behaviors, little attention has been given to the development of a culturally appropriate paradigm for health promotion in the African American community. Currently, culturally sensitive educational and behavioral change models for health promotion in African American communities tend to be based primarily on the Caucasian experience. Attempts to make these programs culturally appropriate tend to rely on the individual and family psychology of African Americans. A major shortcoming of these models is the failure to ground personal crises in the social political context within which the individual has to function. It is critical to establish a balance between behavior the individual is capable of changing and the social-political factors in the environment that must be managed before those changes are made and sustained. The outcome is that these approaches offer no models for translating known cultural and institutional realities into a working framework that could guide the development of culturally appropriate health promotion and disease prevention programs in African American communities. There is no doubt that the failure to recognize the cultural inadequacies of traditional models, so as to promote and educate people to use alternative models, has contributed significantly to the profound disparity in health status between African Americans and the White population. Although efforts seem to be commonly focused on the health of poor African Americans, as if they should be held responsible for their economic status and hence a focus on their behavior, much needs to be done about addressing the contextual environment that breeds disparity. Although SES influences health outcomes, racial and cultural oppression are mostly responsible for the low health status of African Americans. Segregation and poor housing have long been established as rQot causes for poor health of African Americans. In the words of Derrick Bell (1992), the inner city is the American equivalent of South African homelands. Low economic status is linked with poor health status, and other factors, such as structural discrimination and institutional racism, favor the disproportionate representation of African Americans in low-income groups, which ultimately results in their poor health status. A focus on individual income fails to address the social context and environment in which a disproportionate number of African Americans find themselves. Even among African Americans whose income levels are the same as those of the majority White population, many other faetors-c-such as total assets, housing, prior SEB, und social IllobiJity- influence health status (Williams and CoJlins20(4).
Thus the plan: The United States Federal Government should provide all necessary funding for the integration of traditional healers into national public health infrastructures in Sub-Saharan Africa.
Funding and Enforcement Guaranteed
Integration of traditional medicine is crucial to perceptual diversity and polyphasic understanding– this increases knowledge, biodiversity, cultural diversity, and continued evolution
Tara W. Lumpkin, Anthropogist with development experience, 2001. “Perceptual Diversity: Is Polyphasic Consciousness Necessary for Global Survival?” Anthropology of Consciousness. Vol. 12, No. 1, pp. 37-70
Perceptual diversity allows human beings to access knowledge through a variety of perceptual processes, rather than merely through everyday waking reality. Many of these perceptual processes are transrational altered states of consciousness (meditation, trance, dreams, imagination) and are not considered valid processes for accessing knowledge by science (which is based primarily upon quantification, reductionism, and the experimental method). According to Erika Bourguignon's (1973) research in the 1970s, approximately 90 percent of cultures have institutionalized forms of altered states of consciousness, meaning that such types of consciousness are to be found in most human societies and are "normal." Now, however, transrational consciousness is being devalued in many societies as it is simultaneously being replaced by the monophasic consciousness of "developed" nations. Not only are we are losing (1) biodiversity (biocomplexity) in environments and (2) cultural diversity in societies, we also are losing (3) perceptual diversity in human cognitive processes. All three losses of diversity (bio, cultural, and cognitive) are interrelated. Cultures that value perceptual diversity are more adaptable than cultures that do not. Perceptually diverse cultures are better able to understand whole systems (because they use a variety of perceptual processes to understand systems) than are cultures that rely only on the scientific method, which dissects systems. They also are better stewards of their environments, because they grasp the value of the whole of biodiversity (biocomplexity) through transrational as well as scientific processes. Understanding through perceptual diversity leads to a higher degree of adaptability and evolutionary competence. From the perspective of an anthropologist who has worked with development organizations, development will continue to destroy perceptual diversity because it exports the dominant cognitive process of "developed" nations, i.e., monophasic consciousness. Destroying perceptual diversity, in turn, leads to the destruction of cultural diversity and biocomplexity. Drawing from research I conducted among traditional healers in Namibia, I conclude that development organizations need to listen to those who use transrational perceptual processes and also need to find a way to incorporate and validate perceptual diversity in their theoretical and applied frameworks.
Integration would bridge the gap create mutual understanding between western and traditional medicine
Dr. M. Akin Makinde, Head of the Department of Philosophy at the University of Ife, Nigeria, and the holder of the Pd.D. in Philosophy of Science from University of Toronto, ‘88 (African Philosophy, Culture, and Traditional Medicine, p. 97-98)
Only by interrogation of assumptions from our privileged status can we properly engage culture and hope for solvency. Our integration project and concurrent acceptance of culture reveals the truth about cultural paradigms and breaks down the often Eurocentric and patriarchal foundations we usually engage in to achieve public health goals.
Airhihenbuwa 07
[Collins O. Airhihenbuwa, professor of biobehavioral health at Pennsylvania State University. Healing our Differences The Crisis of Global Health and the Politics of Identity. Rowman & Littlefield Publishers, Inc. UK. 2007. 195]
The discourse on identity and global health is incomplete without the proper anchor on culture. Culture should be central to public health and health promotion intervention strategies in a manner that does not naturally couple the concept of barriers with culture. Intervention projects should draw on the possibilities offered in critical theories that lay bare institutional and Western hegemonies that continue to truncate ef/'(xts to address public health issues in Africa. Stuart Hall ( 1992) notes that cultural hegemony is about imbalance of power, and our responsibility, as echoed by Okri at the beginning of this chapter, is the struggle for a balance of power to achieve the best that our humanity exemplifies in social justice.
I have attempted to remap the terrains of conventional theories and cultural logics in health promotion, health communication, and public health by placing them within their particular cultural spaces. By so doing, it is possible to acknowledge that everyone has a culture and that all knowledge production is cultural, and thus all theory is cultural. Such a premise unveils the contextual anchors for theoretical assumptions and praxis so that behaviors are located within cultural spaces. These behaviors are then expressed through different forms of identity as expressed in different behavioral response to health and the lack thereof. What I have attempted in this book is to locate identity and behavior within cultural contexts of health. Thus, it was necessary to challenge existing public health epistemologies by decentering conventional views of health behavior and inserting and centering culture into their theories and practices.
As I have discussed throughout this book, a major requirement in engaging a health and culture project is that we begin with the interrogation of conventional assumptions and classical paradigms and their attendant Eurocentric and often patriarchal foundations. Such interrogation is meant to be a cleansing enterprise that must be engaged in by both the privileged and the marginalized as a liberatory process that allows questioning to become a form of answering. While the privileged interrogate the hegemonic tools of oppression that privilege them, the oppressed and marginalized interrogate their conscious or subconscious participation in promoting ways of knowing that evidently silence their own agency in policies of identity inscribed in the crisis of global health.
The plan represents a move away from the politics of self-interest inherent in the status quo paradigm of health. This is key to jarring the people of the privileged world out of complacency, establishing a new framework regarding our relationships to other countries and creating a truly level playing field in the area of health access.
Solomon R Benatar, Dept. of Medicine and Bioethics @ Cape Town U and Renee C. Fox, Dept. of Sociology and Center for Bioethics @ Penn U, 2005 (“Meeting Threats to Global Health: a Call for American Leadership,” Perspectives in Biology and Medicine 48.3, p. 344-361)
Current and widening disparities in health around the world—even within many countries, including the United States—and the particular plight of Africa during the HIV/AIDS pandemic, together with the implications of new threats from the natural or deliberate spread of infectious diseases (bioterrorism), demonstrate the pressing need for more attention both to moral responsibilities and their underlying values, and to the long-term national interest of wealthy nations in a complex interdependent world. In the visionary words of former President of the Czech Republic, Václav Havel (2002): "If humanity is to survive and avoid new catastrophes, then the global political order has to be accompanied by a sincere and mutual respect among the various spheres of civilization, culture, nations, or continents, and by honest efforts on their part to seek and find the values or basic moral imperatives they have in common, and to build them into the foundations of their coexistence in this globally connected world." Extending the ethics discourse beyond interpersonal relationships to institutional interactions, national approaches to health care, and international relations that have profound effects on population health could help promote the new mindset needed to narrow disparities in health and reduce the potential for new infectious diseases to emerge and rapidly spread globally. Such a mindset requires the realization that health, human rights, economic opportunities, good governance, peace, and development are all intimately linked. The challenges we face in the 21st century are to explore these links, to understand their implications, and to develop processes that could harness economic growth to sustainable human development, progressively narrow global disparities in health, and promote peaceful coexistence (Benatar, Daar, and Singer 2003; Lee, Walt, and Haines 2004). Strategies to effect a new approach to dealing with global health problems will have to address the difficult task of ameliorating constraints that impede the medical profession and other possible change agents from taking an active leadership role in such an effort. These constraints, as we have suggested, include the strong adherence to individualism as a principal cultural value; the types of powerful ideological, political, and economic forces that have perpetuated inequities in access to health care and derailed efforts to develop national health care coverage in the United States; and the fears of many nations about American imperialism. The magnitude and complexity of this task should not be underestimated. Nonetheless, the importance of taking up the challenge also should not be minimized. Privileged people, we believe, need new ways of thinking about the value of the lives of others as well as their own, and about the goals and purposes of medicine and health. Such a requirement cannot be avoided in a world in which almost half the people alive today benefit little if at all from any of the advantages accrued during centuries of progress. New paradigms of thinking and action became vital at various other times in history in the face of profound change, and they are called for again to confront the current threats to human life and security posed by rampant infectious diseases, environmental degradation, and biological terrorism. Those who live, work, and think in rich material and intellectual environments understandably tend to take for granted their wealth, democracy, and civil society (Bethke-Elshtain 1995; Galbraith 1992; Pogge 2001). They may have little direct knowledge or comprehension of how their societies have acquired, and continue to acquire—including through exploitation of distant others—the resources that enable them to lead comfortable lives. They are also remote from the "world of victims" (Farmer 1996, 2003), and from the difficulties faced by colleagues who are endeavoring to sustain universal professional ideals and accessible services in poor, nondemocratic, and oppressive countries, in which a myriad of overt and covert forces influence and obstruct them. The HIV/AIDS pandemic has highlighted some of these issues both in relation to research in developing countries and in making new therapies available to those most in need (Bond 1999; Trouiller, Olliaro, and Torreele 2002). The impact of the SARS epidemic on Toronto was a wake-up call to the fact that privileged societies are not immune to the health, security, and economic threats posed by the emergence and spread of new infectious diseases. As John Kenneth Galbraith (1992) warned many years ago, it is time for privileged people to move beyond self-satisfied complacency. The time is ripe for deep introspection by Americans and other wealthy nations about what they do individually and collectively, and for wider debate about the global impact of the ideology driving highly selfish individualistic behavior. Humility, empathy, and a broad intellectual approach are necessary for several reasons. First, we need to appreciate the pervasiveness of powerful economic and political forces that shaped the past and will shape our future (Donnelly 1989; Falk 1999). Second, this could enable us to better understand the difficulties faced by people in vastly differing societies, and to accept that there is much that can be learned through respect for other cultural perspectives and closer
[Benatar/Fox Continued]
interaction with them. Third, it is necessary to understand that theories and ideas we consider to be universal are to a considerable extent socially constructed and may play out differently in various social and cultural contexts. Finally, we should acknowledge that legitimacy is acquired by those with privilege and power only when they meet their moral obligations to those less fortunate than themselves. Such responsibilities extend beyond merely elaborating universal theories and exhorting others to follow them. Recent human rights abuses at Guantanamo Bay and in the Abu Ghraib prison illustrate how decades of work to promote human rights can be set back by the failure of powerful nations to set an example of the behavior they expect of others. Within the realm of health care, such an introspective approach could deepen our understanding of the extent and depth of conflicts of interest in medical practice and research—a glaring example of which is the pharmaceutical industry's control over global drug prices, which has had markedly adverse effects on the availability of essential drugs in poor countries (Relman and Angell 2001). There is increasing acknowledgement of the need for social justice in the delivery of health care, and escalating urgency both to reclaim much that is being lost in the practice of medicine, and to redefine what is considered necessary for the provision of preventive and curative health care services that meet individual and community needs (Adson 1995; Annas 1995; Buchanan 2001; Lyons 1994; Ste-vens 2001).